What question did this study set out to answer?

This research aims to determine the relationship between low blood pressure during anesthesia and postoperative acute kidney injury in extremely hypertensive patients.

April 1, 2026Open Access

Postoperative Acute Kidney Injury Associated with Anesthesia Induction in Extremely Hypertensive Patients Undergoing Elective Non-Cardiac Surgery

Q: What are the key findings of this study?

In extremely hypertensive patients undergoing elective non-cardiac surgery, the duration of mean arterial pressure < 65 mmHg between intubation and incision independently increased the risk of postoperative acute kidney injury (OR 1.03).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Extreme hypertension (systolic blood pressure ≥ 180 mmHg) before anesthetic induction for elective non-cardiac surgery (n=1024). Intervention: Duration of mean arterial pressure (MAP) < 65 mmHg between intubation and incision vs. Shorter duration or absence of MAP < 65 mmHg. Primary outcome: Postoperative acute kidney injury (AKI) (OR 1.03, 95% CI 1.01-1.05, p=<0.01).

Q: What does this research mean for the field?

In extremely hypertensive patients undergoing elective non-cardiac surgery, the duration of mean arterial pressure < 65 mmHg between intubation and incision independently increases the risk of postoperative acute kidney injury. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Longer duration of MAP <65 mmHg is linked to ~3% higher AKI risk in hypertensive patients.

OR 1.03
95% CI 1.01-1.05
P<0.01
n=1,024

Why the study?

It remains unknown how anesthetic hypotension should be managed in patients with hypertension to prevent major postoperative complications.

Does the duration of intraoperative hypotension (MAP <75 mmHg) increase the risk of postoperative acute kidney injury in patients with extreme preinduction hypertension undergoing non-cardiac surgery?

Population

274 patients with systolic blood pressure >200 mmHg before anesthetic induction undergoing elective non-cardiac surgery

Comparison

Duration of mean arterial pressure below thresholds between intubation and surgery initiation vs non-AKI

Design

Cohort study

Authors

KMKohei MorozumiToho University MSMaiko Satomoto YHYuki HanaiToho University

Discussion

Member takes

Implication

Supports minimizing intraoperative hypotension in extreme hypertension; extends observational AKI risk data to non-cardiac surgery.

Key Points

This research aims to determine the relationship between low blood pressure during anesthesia and postoperative acute kidney injury in extremely hypertensive patients.
Assessed postoperative complications including AKI, myocardial infarction, and ischemic stroke.
Measured durations of mean arterial pressure below various thresholds during surgery.
Conducted multivariate logistic regression analysis to identify risk factors for AKI.
Out of 274 patients, 35 developed acute kidney injury.
Statistically significant longer durations of MAP <65, 70, and 75 mmHg were found in the AKI group.
An independent association was established between MAP <75 mmHg and AKI, with adjusted odds ratio of 1.04.

Study Design

Type

Cohort (n=1,024)

Multicenter

Structured PICO

Population

274 patients aged >20 years undergoing elective non-cardiac surgery with extreme preinduction hypertension (systolic blood pressure >200 mmHg).

Intervention

Duration of mean arterial pressure (MAP) <75 mmHg between intubation and incision during anesthesia.

Outcome

Postoperative acute kidney injury (AKI) defined as a 1.5-fold or 0.3 mg/dL increase in serum creatinine concentration compared to preoperative measurements within 48 hours postoperatively.hard clinical

Main Result

Effect estimate: OR 1.03 (95% CI 1.01-1.05)

p-value: p=<0.01

In patients with extreme preinduction hypertension undergoing non-cardiac surgery, prolonged mean arterial pressure <75 mmHg between intubation and incision is an independent risk factor for postoperative acute kidney injury.

Limitations

Single-center retrospective study design
Potential underestimation of AKI as only patients with serum creatinine tests within 48 hours post-surgery were assessed
Incidence of myocardial infarction and cerebral infarction was too low to assess associations
Institutional policy of delaying surgery for extreme hypertension remains controversial
Potential unmeasured confounding factors despite using a perioperative risk scoring model
Small number of cases may have reduced statistical power for some analyses
Single-center, retrospective study
Only assessed patients who underwent blood tests of serum creatinine concentrations at least once within 48 h from the end of surgery, potentially missing later AKI
Incidence of MI and cerebral infarction was too low to assess associations with MAP
Institutional policy of delaying surgery remains controversial
Potential unmeasured confounding factors not included in the multivariate analysis
Small number of cases reducing statistical power

Cite This Study

Morozumi et al. (2021) conducted a cohort in Extreme hypertension (systolic blood pressure ≥ 180 mmHg) before anesthetic induction for elective non-cardiac surgery (n=1,024). Duration of mean arterial pressure (MAP) < 65 mmHg between intubation and incision vs. Shorter duration or absence of MAP < 65 mmHg was evaluated on Postoperative acute kidney injury (AKI) (OR 1.03, 95% CI 1.01-1.05, p=<0.01). In extremely hypertensive patients undergoing elective non-cardiac surgery, the duration of mean arterial pressure < 65 mmHg between intubation and incision independently increased the risk of postoperative acute kidney injury (OR 1.03).

synapsesocial.com/papers/69cd7a2b5652765b073a7227 https://doi.org/10.14994/tohojmed.2020-018

Topics

Hypertension management

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